U.S. Mayor Article

Eleven Cities in San Juan Metro Area Join Efforts to Promote Good Health, Wellness, Disease Prevention

February 17, 2003


The city of San Juan under the leadership of Mayor Jorge Santini envisioned a joint effort to improve the quality of life of the people of San Juan and neighboring cities, and after many community meetings and discussions, launched a new health alliance program called "Más Salud." Más Salud is the Spanish translation for "more" or "better health." To date, eleven cities in the San Juan metro area have joined with San Juan to help improve the health and health status of their low-income constituents and underserved communities.

Early in 2002, San Juan began these health-oriented municipal partnerships in order to promote health care initiatives already proven to be successful in San Juan. Since then, San Juan has engaged in the most significant transformation of the island's healthcare delivery system for 40 years, introducing new clinical programs and establishing outreach to underserved communities. Mayor Santini says he is convinced that health screenings are an efficient, convenient, economic way to detect problems before they become major health risks.

He also believes strongly that strong community participation is one of the most effective methods for improving community health. Through extensive networking San Juan has conducted greater outreach and community activities.

Flexibility Built on Successful Programs Key to Health of Regional Population

The Capital City of Puerto Rico with a population of almost 440,000, San Juan currently runs prevention programs for breast cancer, diabetes mellitus, hepatitis C, hyperlipidemia and hypertension. The city has committed itself to developing and managing research protocols in the areas of prostate and breast cancer, diabetes, and Alzheimer's disease among others.

Through Más Salud, neighboring or 'sister- cities get technical and professional support in order to develop their own prevention models, best suited to the particular needs of their own residents. Moreover, San Juan allows each participating sister city the benefit of subscribing eligible constituents in San Juan's revolutionary "Golden Relief Program." This is an innovative project that allows the elderly to acquire prescription drugs at a 50 percent discount. The Más Salud Program is structured so participating cities can focus on the unique health needs of its own residents to improve health status.

Building on Existing Capacity Means Efficient Win-Win

Evaluation and situational analysis is the critical initial step because many participating cities lack the capacity to ensure delivery of preventive attention. Más Salud provides education, screening, testing and referral for those patients with acute medical needs in all the participating cities.

In contrast, San Juan is fortunate to have a multi-level Department of Health with an annual operating budget of $95 million and 2,500 employees. The City of San Juan operates ten community medical centers, eight emergency rooms that are open 24 hours a day, a 200-bed in-patient rehabilitation facility, a 300-bed tertiary care hospital, a multidisciplinary, multi'specialty HIV/AIDS clinic, two research centers and more than fifteen clinical programs. Many patients already benefiting from the program, have stated that Más Salud is their first medical encounter in many years.

The Más Salud program has also had a significant impact on San Juan's economy. Since 2000, San Juan has been billing the health insurance companies for the services provided to their customers, serviced through the Más Salud program. This has effectively allowed San Juan's Department of Health to promote its services and encourage use of the Department's facilities and services. The increase in the use of services and facilities provides additional economic opportunity and this has had a positive effect on the city's estimated revenues. By the end of this fiscal year, San Juan expects to have increased it's billing by approximately $2 million over 2002.

Program Structure Promotes Wellness, Integrates Health Fairs, Prescription Drug Component

The program has an appointed full-time alliance manager charged with financial, economic and professional program support to ensure progressive improvement and sustainability. The manager is also responsible for maintaining the already established positive cooperative working relationships with the partnering sister cities. To further emphasize San Juan's commitment to this cooperation, Mayor Santini's administration issued a municipal declaration and formally executed intergovernmental agreements to ensure the long-term success and viability of such a far-reaching cooperative program.

Health Fairs

The San Juan Department of Health holds health fairs to reach people who normally would not have access to health education or screening tests. The fairs provide attendees with tests and health information free of charge and Department clinical staff attend in order to answer questions and share information and materials for future reference. They also perform all the screenings and tests. San Juan has also organized and manages a large contingent of community volunteers to staff the fairs. Each of the partner cities is responsible for the logistics and support required to carry out the fair.

At each community fair, screenings are provided for depression, cholesterol, hypertension, renal disease, and thyroid tests, among others are also administered. To date, these health fairs, supported and sponsored directly by the City of San Juan have serviced over 16,232 people and have performed 23,727 tests.

Golden Relief Prescription Drug Program

San Juan has also become a leader in developing, marketing and operating the largest free prescription drug savings program in Puerto Rico. Targeted to the uninsured and under-insured, enrollment in the program, which is free, provides members with savings of up to 50 percent on brand name prescription drugs. In addition, participants can save on all their generic drug purchases. The program covers medications for common health problems such as heart disease, high blood pressure, high cholesterol, diabetes, estrogen replacement, depression, dermatological treatments, antibiotic treatments, osteoporosis, ulcers, asthma, allergies amongst others.

San Juan contracted several community pharmacies to provide the beneficiary with freedom of choice and access to the service. Participating pharmacies are located in every participating sister city. Every participant is provided with a distinctive identification card that must be presented at the pharmacy at the time of purchase in order to receive the discount.

For more information on San Juan's Más Salud or Golden Relief Programs please contact Alfredo L. Escalera, MD, Executive Director, City of San Juan Department of Health, PO Box 21405, San Juan, Puerto Rico 00928 Tel: (787) 977-0520

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